The proposed study is an examination of cultural meaning, social interaction, and individual experience among adolescent patients in treatment for psychiatric disorder in the American Southwest (Arizona and New Mexico). Our long-term goal is to produce knowledge of broad use to those concerned with the treatment of adolescents suffering from mental illness in the context of significant cultural differences. The design is to compare the experience of consenting Navajo (n=16), Pueblo (n=16), Hispanic (n=16, Euro-American (n=16), and African-American (n=6) patients and a parent/guardian of each from admission through one year subsequent to discharge, using a combination of naturalistic observation, open-ended ethnography of a new inpatient unit that for the first time in history will provide on reservation residential psychiatric care for the most distressed among Navajo youth ages 12 to 18. The unique nature of the unit suggests that its treatment program will be treated as a model for other such facilities in the future, and therefore through going ethnographic description of the cultural processes relevant to its functioning is necessary and even urgent. We will interview a comparison group of 50 students drawn from public schools to establish a baseline for analysis. Analysis will emphasize descriptive ethnography, ranging from cultural conceptualization of community mental healthcare, to narrative case accounts of individual patients as they move from clinic to family, school, and religious settings. Ethnography will be complemented by quantitative analyses to determine how youth from different ethnic backgrounds differ on a variety of measures. Specific aims are organized under three interrelated headings: 1) Clinical Culture and Development of Treatment - To trace the development of a clinical culture and culturally sensitive treatment program within the new inpatient psychiatric unit and to compare patient, family and staff initial expectations about the new unit and the way those expectations are played out behaviorally in practice. 2) Definitions of Distress and Adolescent Development - To compare concepts of problem, illness, or disorder defined in psychiatric terms with patient and family understandings of young people's distress and the potential stigma associated with that distress, and to compare concepts of development, growth, and maturity across cultural groups with respect to contemporary cultural issues and obstacles faced by youth, 3) Therapeutic Process and Perception of Treatment - To describe patient experience of therapeutic process as they move from the community into treatment and back into the community, and to determine whether treatment in the new facility makes a difference for patients by comparing them to peers who have no disorder or history of interaction with the mental health care system.